Return Home. "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV" Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, 1996.
|
|
- Sheryl Mathews
- 5 years ago
- Views:
Transcription
1 Return Home ABSTRACT "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV" Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, by Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes certain sexual disorders which are characterized by, or include among their features, excessive and/or unusual sexual urges or behaviors. Common disorders in the differential diagnosis include paraphilias, impulse disorder not otherwise specified (NOS), sexual disorder NOS, bipolar affective disorder, cyclothymic disorder, post-traumatic stress disorder, and adjustment disorder. Infrequent disorders in the differential diagnosis consist of substance-induced anxiety disorder, substance-induced mood disorder, dissociative disorder, delusional disorder (erotomania), obsessive-compulsive disorder, gender identity disorder, and delirium, dementia, or other cognitive disorder. Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence. The need for a classification of mental disorders has been clear throughout the history of medicine, but there has been little agreement on which disorders should be included and the optimal method for the organization. The many nomenclatures that have been developed during the past two millennia have differed in their relative emphasis on phenomenology, etiology, and course as defining features (DSM- IV, Introduction, p. xvi).the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980) represented a major advance in the diagnosis of mental disorders and greatly facilitated empirical research. The development of DSM-IV (1994) benefitted from the substantial increase in research on diagnosis that was generated in part by DSM-III and DSM-III-R. In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome must not be merely an expected and culturally sanctioned response to a particular event. Neither deviant behavior (e.g. political, religious, or sexual), nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above (DSM-IV, Introduction, p. xxi). When the DSM-IV categories, criteria, and textual descriptions are employed for forensic purposes, there are significant risks that diagnostic information will be misused or misunderstood. In most situations, the clinical diagnosis of a DSM-IV mental disorder is not sufficient to establish the existence for legal purposes of a "mental disorder," "mental disability," or "mental disease." In determining whether an individual meets a specified legal standard (e.g. for criminal responsibility or disability), additional information is usually required beyond that contained in the DSM-IV diagnosis. Even when diminished control over one's behavior is a feature of the disorder, having the diagnosis in itself does not demonstrate that a particular individual is (or was) unable to control his or her behavior at a particular time. The use of DSM-IV in forensic settings should be informed by an awareness of the risks and
2 limitations discussed above (DSM-IV, Introduction, pg xxiii). The descriptive term "sexual addiction" does not appear in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Addiction professionals who encounter both compulsive and impulsive sexual acting-out behaviors in their patients have experienced paradigm and nomenclature communication difficulties with mental health professionals and managed care organizations who utilize DSM terminology and diagnostic criteria. This difficulty in communication has fueled skepticism among some psychiatrists and other mental health professionals regarding the case for including sexual addiction as a mental disorder. The goal of this paper is to familiarize addiction practitioners and counselors with how sexual behaviors involving sexual excesses, improprieties, and/or urges are categorized in the DSM-IV. It is our hope that this will encourage and permit more rigorous diagnostic classification of sexually troubled individuals by addiction professionals, demonstrate to mental health professionals that addictive sexual behaviors are indeed subsumed in various categories of the DSM-IV, and facilitate communication between all concerned parties. Current DSM Nosology The DSM-IV is written in clear language and easily understood by non-psychiatrists. For each disorder it provides a detailed description of its diagnostic features, subtypes if any, associated features and disorders, course of the illness, and differential diagnosis."differential diagnosis" refers to a list of all other disorders which might cause the same symptoms. After the detailed description of each disorder, there is a summary of the diagnostic criteria and sometimes a statement about how mlisted criteria must be present in order to make the diagnosis. The DSM-IV defines a mental disorder as "a clinically important collection of symptoms (these can be behavioral or psychological) that causes an individual distress, disability, or the increased risk of suffering pain, disability, death, or the loss of freedom." The DSM-IV follows the medical model of illness, meaning that it is a descriptive work derived from scientific studies of groups of patients who appear to have a great deal in common, including symptoms, signs, and life course of their disease (Morrison, p.8) Complete assessment of a patient according to the DSM-IV involves evaluation along five axes. Axis I diagnoses are clinical disorders, including cognitive disorders (such as delirium, dementia, and amnesia), mood disorders (such as depression or bipolar illness), anxiety disorders, schizophrenia and other psychotic disorders, substance-related disorders, dissociative disorders, sexual and gender identity disorders, eating disorders, sleep disorders, and impulse-control disorders. Axis II codes personality disorders and mental retardation. The former includes characterologic disorders and prominent maladaptive personality features. Disorders in this Axis may be considered the principal diagnosis. Axis III describes general medical conditions that are potentially relevant to the understanding or management of the individual's mental disorder. Axis IV is for reporting psychosocial and environmental problems that may affect the treatment and prognosis of mental disorders (such as financial, legal, and relationship problems), and Axis V scores the patient's current overall occupational, psychological, and social functioning, recorded as a single number on a scale from 1 to 100. Patients may have one or more diagnoses from any of the first three axes. The use of the multiaxial system facilitates comprehensive and systematic evaluation with attention to the entire person and their biopsychosocial environment, including the level of functioning which might be overlooked if the focus were on assessing a single presenting problem. A multiaxial system provides a comprehensive format for organizing and communicating clinical information, for capturing the complexity of clinical situations, and for describing the heterogeneity of individuals presenting with the same diagnosis. (DSM-IV, p.25)
3 It is important to note that notions of deviance, standards of sexual performance, and concepts of appropriate gender role can vary from culture to culture. The DSM-IV was extensively validated on American populations, and cannot be indiscriminately applied to other cultures. The provision of a culture-specific section in the DSM-IV text, the inclusion of a glossary of culture bound syndromes, and the provision of an outline for cultural formulation are designed to enhance the cross-cultural applicability of DSM-IV (DSM-IV, p.xxv). The DSM-IV mental disorders are grouped into sixteen major diagnostic classes, one of which is entitled Sexual and Gender Identity Disorders. The sexual disorders are subdivided into three categories, Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders, as well as a catch-all category called Sexual Disorder Not Otherwise Specified (NOS). The Sexual Dysfunctions are characterized by disturbance in sexual desire and in the psychophysiological changes that constitute the sexual response cycle. These disturbances result in decreased sexual desire and/or performance and cause marked distress and interpersonal difficulty. Sexual Dysfunctions include Low Sexual Desire Disorders (Hypoactive Sexual Desire Disorder and Sexual Aversion Disorder), Sexual Arousal Disorders (Female Sexual Arousal Disorder and Male Erectile Disorder), Orgasmic Disorders (Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation), and Sexual Pain Disorders (Dyspareunia, or genital pain during intercourse, and Vaginismus, or severe vaginal spasm which causes pain for a woman and interferes with penetration). There is also a group of Secondary and Other Sexual Dysfunctions, which include Sexual Dysfunction Due to a General Medical Condition, Substance-Induced Sexual Dysfunction, and a residual category, Sexual Dysfunction Not Otherwise Specified (NOS). The paraphilias are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations that occur over a period of at least six months and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. For some individuals, paraphilic fantasies or stimuli are obligatory for erotic arousal and are always included in sexual activity; in other cases, the paraphilic preferences occur only episodically, while at other times the person is able to function sexually without paraphilic fantasies or stimuli. In contrast to the Dysfunctions, which are associated with decreased sexual functioning, the Paraphilias are commonly associated with increased sexual activity, often with compulsive and/or impulsive features. Paraphilic sexual activity revolves around fantasies, urges, or behaviors that are considered unusual or frankly deviant by society and generally involve (a) nonhuman objects or animals; (b) humiliation or suffering of the patient or partner, or (c) nonconsenting persons, including children. Even when such urges or fantasies are not acted upon, the level of distress may be sufficient to warrant a diagnosis; far more commonly, paraphiliacs have acted upon their desires many times before a diagnosis is made (Morrison, 1995, p. 360). Gender Identity Disorders (transsexualism), a third type of sexual disorder, are characterized by strong and persistent cross-gender identification accompanied by persistent discomfort with one's assigned sex. Transsexuals cross-dress to look like the other sex, not specifically for sexual stimulation. They may be sexually attracted to males, females, both, or neither. Sexual Disorder Not Otherwise Specified (NOS) is included for coding disorders of sexual functioning that are not classifiable in any of the specific categories. One of the three examples given for this disorder is "Distress about a pattern o repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used" (DSM-IV. 638). This diagnosis has historically been the most common one to be used for patients identified as sexual addicts. Addictive Sexual Disorders The range of fantasies, urges, and behaviors which can be considered addictive sexual disorders may be
4 appreciated by reviewing the ten categories developed by Carnes (1991): Table 1: Patterns and Themes of Sexual Addiction 1. Fantasy sex: Items focused on sexual fantasy life and consequences due to obsession. Themes include denial, delusion, and problems due to preoccupation. 2. Seductive role sex: Items focused on seductive behavior for conquest. Multiple relationships, affairs, and unsuccessful serial relationships. 3. Anonymous sex: engaging in sex with anonymous partners, having one-night stands. 4. Paying for sex: paying prostitutes for sex, paying for sexually explicit phone calls. 5. Trading sex: receiving money or drugs for sex or using sex as a business. Highly correlated were swapping partners and using nudist clubs to find sex partners. 6. Voyeuristic sex: Items focused on forms of visual sex, including pornography, window peeping, and secret observation. Highly correlated with excessive masturbation, even to the point of injury. 7. Exhibitionist sex: exposing oneself in public places or from the home or car; wearing clothes designed to expose. 8. Intrusive sex: touching others without permission, using position or power (e.g. professional, religious) to sexually exploit another person; rape. 9. Pain exchange: causing or receiving pain to enhance sexual pleasure. Use of dramatic roles, sexual aids, and animals were common themes. 10.Exploitive Sex: Use of force or partner vulnerability to gain sexual access. Five of Carnes' categories can be readily identified in the DSM-IV as specific paraphilias. These include voyeuristic sex, exhibitionistic sex, pain exchange (sexual sadism, sexual masochism), as well as some types of intrusive sex (frotteurism), and exploitive sex (pedophilia). Four of the remaining categories may be correlated with paraphilias: fantasy sex may be associated with paraphilic urges not acted upon, anonymous sex may be used to permit expression of paraphilic behavior with decreased risk of consequences, and paying for sex or trading sex are means by which a partner who may permit paraphilic activity may be purchased. Sexual improprieties and excesses that are considered addictive in nature can usually be classified into one of three major DSM-IV categories: Paraphilia (either one or more specifically identified in the DSM-IV or Paraphilia NOS), Impulse Control Disorder NOS, or Sexual disorder NOS. When the behavior does not fit easily into one of these categories, and is not considered a manifestation of some other DSM IV Axis I diagnosis, then it can be diagnosed a work-related problem or a relational problem, utilizing a V code on Axis I. Impulse-Control Disorders is another DSM-IV category which may include sexual behaviors. Some authors have considered compulsive sexual behavior to be essentially an impulse control disorder (e.g., Barth and Kinder (1987)). In our opinion, some cases of sexual excess represent an impulse-control disorder, whereas most cases are attributable to other DSM diagnoses which embrace the predominant compulsive features associated with sexual acting out. The essential feature of Impulse-Control Disorders is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others. The individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure, gratification, or relief associated with the activity. Following the sexual acting out, there may or may not be regret, self-reproach, or guilt.
5 The premier example of an Impulse-control disorder listed in the DSM-IV is Pathological Gambling (DSM-IV, p.618): Table 2: Diagnostic criteria for Pathologic Gambling A persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following: (1) is preoccupied with gambling (preoccupation). (2) needs to gamble with increasing amounts of money in order to achieve the desired excitement. (tolerance) (3) has repeated unsuccessful efforts to control, cut back, or stop gambling (loss of control). (4) is restless or irritable when attempting to cut down or stop gambling (withdrawal symptoms). (5) gambles as a way of escaping from problems or of relieving a dysphoric mood (preoccupation). (6) after losing money gambling, often returns another day to get even ["chasing" one's losses] (loss of control) (7) lies to family members, therapist, or others to conceal the extent of involvement with gambling (continues despite adverse consequences) (8) has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling (adverse consequences). (9) has jeopardized or loss a significant relationship, job, or educational or career opportunity because of gambling (adverse consequences). (10) relies on others to provide money to relieve a desperate financial situation caused by gambling (adverse consequences). After each criterion we have appended what we consider the essential element which may be associated with an addictive disorder. It is instructive to compare this list with the DSM-IV criteria for a substancerelated disorder (DSM-IV, p.181): Table 3: Diagnostic Criteria for Substance Dependence A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: (1) Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect. b. Markedly diminished effect with continued use of the same amount of the substance. (2) Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
6 (3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control). (4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control). (5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation). (6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences). (7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. (adverse consequences). Note that although pathological gambling is classed as an Impulse-Control Disorder whereas Substance Dependence is an addiction, the criteria are in fact very similar. Both sets of criteria involve preoccupation, loss of control, continuation despite adverse consequences, development of tolerance with prolonged use, and withdrawal symptoms when use is stopped. Such overlap is also seen elsewhere in the DSM-IV, and accounts for some of the difficulty and disagreements clinicians sometimes have in diagnosing particular disorders. As stated above, the DSM-IV category of Sexual Disorder NOS specifically cites as an example the person who experiences a series of lovers only as things to be used. This category may therefore be correlated with addictive sexual behavior identified in the Carnes categories of anonymous sex, paying for sex, trading sex, and certainly seductive-role sex. What of other compulsive sexual behaviors which don't clearly fit into these categories, such as fantasy sex, seductive role sex, and compulsive masturbation? If they cause distress to the person, they can be diagnosed as Sexual Disorder NOS, which is defined as "a sexual disturbance that does not meet the criteria for any specific Sexual Disorder and is neither a Sexual Dysfunction nor a Paraphilia." It is, however, instructional to see how such behaviors fit the diagnostic criteria for substance-related disorder as shown in Table 3. Based on his observation of patients with compulsive sexual behavior as well as on the similarities between pathological gambling and addictive use of a substance, Goodman (1990) suggested a list of criteria for any addictive disorder: Table 4: Criteria for Addictive Disorder A. Recurrent failure to resist impulses to engage in a specified behavior. B. Increasing sense of tension immediately prior to initiating the behavior. C. Pleasure or relief at the time of engaging in the behavior. D. At least five of the following: 1. Frequent preoccupation with the behavior or with activity that is preparatory to the behavior. 2.Frequent engaging in the behavior to a greater extent or over a longer period than intended. 3. Repeated efforts to reduce, control, or stop the behavior.
7 4. A great deal to time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects. 5. Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations. 6. Important social, occupational, or recreational activities given up or reduced because of the behavior. 7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior. 8. Tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect, or diminished effect with continued behavior of the same intensity. 9. Restlessness or irritability if unable to engage in the behavior. E. Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer period of time. According to Goodman's definition, any behavior that is used to produce gratification and to escape internal discomfort can be engaged in compulsively and can constitute an addictive disorder. Substance dependence, Impulse-Control Disorder, and Obsessive-Compulsive Disorder all include these elements. Schneider (1994) summarized the key elements of any addictive disorder as loss of control, continuation despite adverse consequences, and preoccupation or obsession. As stated above, there is significant overlap among DSM-IV diagnostic criteria, so it is possible for a single disorder to fit more than one diagnostic category. Some cases of compulsive sexual behavior may fit into the Impulse-Control Disorder NOS and Sexual Disorder NOS, as well as fulfill the criteria for an addictive disorder. To remain within DSM terminology, Irons and Schneider (1994) code the results of Irons' assessments using Paraphilia (either one or more specifically identified in the DSM-IV, or Paraphilia NOS), Impulse Control Disorder NOS, or Sexual Disorder NOS, but always with the inclusion of appropriate and relevant descriptors. Frequently addictive features are present. Other descriptors used include assaultive, compulsive, dissociative, ego dystonic, ego syntonic, exploitive, paraphþ꺫þ Ðtandard for diagnostic criteria and the classification of mental disorders which may result in out-ofcontrol sexual thoughts and acting out. Rather than attempting to fit all cases into one model, addiction treatment professionals need to be know þ꺫þ ÐÆ[YW ø ÿá D Ygn W e TÉ Ç<Ù} bé B 0e Ö`ñÊ ŽÆ[ W 0e Ö ŽÆ[ Wªª Oÿÿ öù " )Úledgeable about the spectrum of mental disorders that may be associated with sexuaor addictive disorder. The complete differential diagnosis is presented in Table 5; some of the disorders will be discussed below. Table 5: Axis I Differential diagnosis of excessive sexual behaviors Common: Paraphilias Sexual disorder NOS Impulse control disorder NOS Bipolar affective disorder (type I or II) Cyclothymic disorder
8 Post-traumatic stress disorder Adjustment disorder [disturbance of conduct] Infrequent: Substance-induced anxiety disorder [obsessive-compulsive symptoms] Substance-induced mood disorder [manic features] Dissociative disorder Delusional disorder [erotomania] Obsessive-compulsive disorder Gender identity disorder Delirium, dementia, or other cognitive disorder. Among the common diagnoses we have not yet discussed, manic-depressive illness, now called bipolar affective disorder, is frequently characterized by sexual excesses in the manic phase. According to the DSM-IV (p ), "The expansive quality of the mood is characterized by unceasing and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions...the increase in goaldirected activity often involves excessive planning of, and excessive participation in, multiple activities (e.g. sexual...) Increased sexual drive, fantasies, and behavior are often present." Cyclothymic disorder can be viewed as a scaled-down version of bipolar illness. Its essential feature is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Hypersexuality may be seen during the hypomanic periods. Substance-induced mood changes such as anxiety or euphoria may result in sexual preoccupation and activity, which can be then considered secondary to the substance use rather than an independent diagnosis. The challenge often is to sort out the role of the chemical use in the sexual compulsivity. For example, Washton (1989) reported that 70% of patients enrolled in his outpatient cocaine addiction treatment center exhibited sexual compulsivity. He found that some of these patients had had no sexually addictive behaviors prior to cocaine use, and had no difficulty with sexual excess once cocaine use was stopped; clearly their sexual behaviors were secondary to cocaine abuse. Other patients, who showed evidence of an addictive sexual disorder antedating their cocaine use, clearly have two separate addictions. Still others found it difficult to stop their compulsive sexual behaviors after stopping cocaine use and form a gray area; their addictive sexual disorder may have originally been secondary to cocaine use, but seemed to have taken on a life of its own and needed to be treated in its own right. Just as mood-alteration by chemicals can affect a person's sexuality, so can cognitive disorders. Dementia and delirium result in loss of the ability to judge the appropriateness of various behaviors; public masturbation, inappropriate sexual touching, and uninhibited language may be expressions of the altered social awareness. Obsessive-Compulsive Disorder (OCD, which must be differentiated from a separate, Axis II, diagnosis of Obsessive-Compulsive Personality Disorder), has as its essential features (DSM IV, p ) "recurrent obsessions or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment. At some point during the course of the disorder,the person has recognized that the obsessions or compulsions are excessive or unreasonable...the most common obsessions are repeated thoughts about contamination, repeated doubts... and sexual imagery (e.g. a
9 recurrent pornographic image... The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., compulsion... Compulsions are repetitive behaviors (e.g., handwashing, ordering, checking) or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification". Some sexologists, such as Eli Coleman (1990), consider sexual compulsivity to be a variant of OCD. We agree that sexual obsessions may be an aspect of OCD. However, when compulsive sexual behavior is the primary disorder, the DSM-IV (p ) specifically rules out the diagnosis of OCD. It says, "Some activities such as eating (e.g. Eating Disorders), sexual behavior (e.g. Paraphilias, gambling (e.g. Pathological Gambling), or substance use (e.g. Alcohol Dependence), when engaged in excessively, have been referred to as 'compulsive.' However, these activities are not considered to be compulsions as defined in this manual because the person usually derives pleasure from the activity and may wish to resist it only because of its deleterious consequences." When sexual or seductive (romantic) behavior is the focus of obsessive mental activity, is neither acted upon nor produces gratification, and is causing significant distress, then it may meet the criteria for OCD. In our experience, such rare cases are associated with nonsexual behavioral manifestations of OCD. Delusional disorder is the presence of one or more nonbizarre delusions that persist for at least a month. Apart from the direct impact of the delusion, the person's behavior appears normal and their psychosocial functioning is not markedly impaired. The delusion may be of being a prominent person or having a special relationship with such a person, or that the patient's spouse or lover is unfaithful, or that the patient is being conspired against, or that the patient has an infestation of insects on the skin or a bad odor. In the erotomanic type of delusional disorder (DSM-IV, p.197), "the central theme of the delusion is that another person is in love with the individual. The delusion often concerns idealized romantic love and spiritual union rather than sexual attraction. The person about whom this conviction is held is usually of higher status, but can be a complete stranger." Completing the Diagnosis of Addictive Sexual Disorders Developing a systematic way of completing a comprehensive DSM diagnosis will facilitate communication with mental health professionals as well as third-party payors. It is helpful to complete the differential diagnosis on Axis I before considering Axes II and III. Sexual disorders, impulse control disorders and paraphilias, when identified, should be described as precisely as possible. If the NOS category is utilized, then it is important to use appropriate descriptors that define the features seen. For example, a lawyer who has exhibited a pattern of sexual involvement with his clients might be diagnosed with "Sexual Disorder NOS with Addictive and Exploitative Features." The severity of the disorder, duration, current level of activity, and amenability to treatment should also be recorded. In the differential diagnosis of sexual improprieties and excesses, Axis II characterologic disorders and traits are often contributory, or may be considered the primary etiology of paraphilic sexual behavior. For example, narcissistic personality disorder is associated with a person who has a grandiose sense of selfimportance, a sense of entitlement, requires excessive admiration, believes he or she is "special," unique, and can only be understood by other special people, is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love, is interpersonally exploitative, lacks empathy, is often envious of others or believes others are envious of them, and shows arrogant, haughty behaviors or attitudes. Such an individual may readily view another person as an object to be used for one's own sexual pleasure. Although these personality characteristics may be seen as defects of character than can be resolved over time through unconditional surrender and dedication to a twelve-step program of recovery, some individuals are "unfortunates" -- and remain naturally incapable of grasping and developing a manner of living which demands rigorous honesty (AA Big Book, p. 58). Such constitutional incapability is the essence of sexual excess that should be relegated to the primary diagnosis of a personality disorder. Conclusion
10 The DSM-IV is our current standard for diagnostic criteria and the classification of mental disorders which may result in out-of-control sexual thoughts and acting out. Rather than attempting to fit all cases into one model, addiction treatment professionals need to be knowledgeable about the spectrum of mental disorders that may be associated with sexual fantasy, urges, and behaviors. Even when the term sexual addiction is the most straightforward identification, and the one best received by the patient, the DSM-IV must be utilized for organizing, thinking about, and reporting the diagnosis. REFERENCES Alcoholics Anonymous, Third Edition, New York: Alcoholics Anonymous World Services, Inc. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Washington, D.C. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Washington, D.C. Barth, RJ and Kinder, BN, The mislabeling of sexual impulsivity. J. Sex Marital Therapy 13(1): Carnes, Patrick, Don't Call it Love. New York: Bantam. Coleman, Eli, The obsessive-compulsive model for describing compulsive sexual behavior. Amer. J. Prev. Psychiatr. Neurol 2:9-14. Goodman, Aviel, Addiction: Definition and implications. Brit J Psychiatry 85: Irons, Richard, and Schneider, Jennifer, Sexual addiction: Significant facor in sexual exploitation by health care professionals. Sexual Addiction Compulsivity 1(3): Morrison, James, DSM-IV Made Easy: The Clinician's Guide to Diagnosis. New York: Guilford Press. Schneider, Jennifer P., Sexual addiction: Controversy in mainstream addiction medicine, DSM-III- R diagnosis, and physician case histories. Sexual Addiction & Compulsivity 1(1): Washton, Arnold, Cocaine may trigger sexual compulsivity. US J Drug Alcohol Depend 13(6):8. Comments to jennifer@jenniferschneider.com
Alphabetical Listing of DSM-IV Sexual and Gender Identity Disorders Reviewed
Alphabetical Listing of DSM-IV Sexual and Gender Identity Disorders Reviewed Handbook of Sexual and Gender Identity Disorders Edited by David L. Rowland and Luca Incrocci Copyright 2008 John Wiley & Sons,
More informationAddiction: definition and implications
British Journal of Addiction (1990) 85, 1403-1408 COMMENTARY Addiction: definition and implications AVIEL GOODMAN, M.D. Minnesota Institute of Psychiatry, 1347 Summit Avenue, St Paul, MN 55105, USA Abstract
More informationPsychosis, Mood, and Personality: A Clinical Perspective
Psychosis, Mood, and Personality: A Clinical Perspective John R. Chamberlain, M.D. Assistant Director, Psychiatry and the Law Program Assistant Clinical Professor University of California San Francisco
More informationSEXUAL DYSFUNCTION & GENDER IDENTITY DISORDER. Elmeida Effendy-Vita Camellia Psychiatric Department- Medical Faculty USU
SEXUAL DYSFUNCTION & GENDER IDENTITY DISORDER Elmeida Effendy-Vita Camellia Psychiatric Department- Medical Faculty USU Sexual behaviour diverse & determined by: A complex interaction of factors It is
More informationChapter 13. Sexual Variants, Abuse, and Dysfunctions. Sexual Abuse. Sexual and Gender Variants
Chapter 13 Sexual Variants, Abuse, and Dysfunctions This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including
More informationPsychopathology Sexual and Gender Identity Disorders
Psychopathology Sexual and Gender Identity Disorders What you should know when you finish studying Chapter 10: 1. Stages of Sexual Responding desire, arousal, and/or orgasm 2. Sexual Dysfunctions that
More informationSexual and Gender Identity Disorders
Sexual and Gender Identity Disorders This section contains the Sexual Dysfunctions, the Paraphilias, and the Gender Identity Disorders. The Sexual Dysfunctions are characterized by disturbance in sexual
More informationWhat is the DSM. Diagnostic and Statistical Manual of Mental Disorders Purpose
DSM 5 The Basics What is the DSM Diagnostic and Statistical Manual of Mental Disorders Purpose Standardize diagnosis criteria (objectivity) Assist in research Provide common terminology Public health statistics
More informationCHAPTER 11: SEXUAL AND GENDER PROBLEMS KEY TERMS
CHAPTER 11: SEXUAL AND GENDER PROBLEMS KEY TERMS Androgens The most important of the male hormones. Unusual sexual behaviour, such as impulsive sexual offending involving non-consenting others, may be
More informationFOUR SELF-TESTS: SEXUAL ADDICTION, SEXUAL ANOREXIA, BINGE-PURGE, COLLATERAL INDICATORS
FOUR SELF-TESTS: SEXUAL ADDICTION, SEXUAL ANOREXIA, BINGE-PURGE, COLLATERAL INDICATORS 1. SEXUAL ADDICTION CRITERIA Each of the sexual addiction criteria is listed below. Record whether you think your
More informationDSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder
DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder PTSD When an individual who has been exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and avoidance
More informationSexual Disorders and Gender Identity Disorder
Sexual Disorders and Gender Identity Disorder Chapter 13 Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 8e Sexual Disorders and Gender Identity
More informationPathological Gambling Report by Sean Quinn
Pathological Gambling Report by Sean Quinn Signs of pathological gambling A persistent and recurrent maladaptive gambling behavior is indicated by five or more of the following: Is preoccupied with gambling
More informationDSM5: How to Understand It and How to Help
DSM5: How to Understand It and How to Help Introduction: The DSM5 is a foreign language! Three Questions: I. The first was, What the key assumptions made to determine the organization of the DSM5? A. Mental
More informationParaphilias. Cornelia Pinnell, Ph.D. Argosy University/Phoenix
Paraphilias Cornelia Pinnell, Ph.D. Argosy University/Phoenix Lecture Outline Definitions Epidemiology Etiology Diagnostic features Course and prognosis Treatment issues Psychopatia Sexualis Krafft-Ebbing
More informationWhat is Gambling? Gambling or ludomania is an urge to continuously gamble despite harmful negative consequences or a desire to stop.
By Benjamin Bunker What is Gambling? Gambling or ludomania is an urge to continuously gamble despite harmful negative consequences or a desire to stop. What is Gambling? Pt. 2 Gambling is an Impulse Control
More informationMental Health Nursing: Sexual Disorders. By Mary B. Knutson, RN, MS, FCP
Mental Health Nursing: Sexual Disorders By Mary B. Knutson, RN, MS, FCP Definition of Sexuality A desire for contact, warmth, tenderness, and love Adaptive sexual behavior is consensual, free of force,
More informationChapter 1. Introductory Information for Therapists. Background Information and Purpose of This Program
Chapter 1 Introductory Information for Therapists Background Information and Purpose of This Program Changes in gaming legislation have led to a substantial expansion of gambling opportunities in America,
More informationDeconstructing the DSM-5 By Jason H. King
Deconstructing the DSM-5 By Jason H. King Assessment and diagnosis of sexual and gender-related disorders The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) presents
More informationsubstance use and mental disorders: one, the other, or both?
substance use and mental disorders: one, the other, or both? Stephen Strobbe, PhD, RN, PMHCNS-BC, CARN-AP Dawn Farm Education Series St. Joe s Education Center, Ypsilanti, MI Tuesday, January 27, 2015
More informationWhat are Sexual Disorders?
What are Sexual Disorders? CLASS OBJECTIVES: What is Gender Identity Disorder? What are Paraphilias? What is Normal Sexual Behavior? Get into groups of 3-4 Take the sexual behavior survey When evaluating
More informationVisualizing Psychology
Visualizing Psychology by Siri Carpenter & Karen Huffman PowerPoint Lecture Notes Presentation Chapter 13: Psychological Disorders Siri Carpenter, Yale University Karen Huffman, Palomar College Lecture
More informationOffice Practice Coding Assistance - Overview
Office Practice Coding Assistance - Overview Three office coding assistance resources are provided in the STABLE Resource Toolkit. Depression & Bipolar Coding Reference: n Provides ICD9CM and DSM-IV-TR
More information7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER TWELVE CHAPTER OUTLINE. Sexual and Gender Identity Disorders. Oltmanns and Emery
ABNORMAL PSYCHOLOGY SEVENTH EDITION Oltmanns and Emery PowerPoint Presentations Prepared by: Ashlea R. Smith, Ph.D. This multimedia and its contents are protected under copyright law. The following are
More information8/23/2016. Chapter 34. Care of the Patient with a Psychiatric Disorder. Care of the Patient with a Psychiatric Disorder
Chapter 34 Care of the Patient with a Psychiatric Disorder All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Care of the Patient with a Psychiatric
More informationDSM-5 UPDATE. Supplement to DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION
DSM-5 UPDATE Supplement to DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION October 2017 DSM-5 Update October 2017 Supplement to Diagnostic and Statistical Manual of Mental Disorders,
More informationOverview of DSM Lecture DSM DSM. Multiaxial system. Multiaxial system. Axis I
DSM Overview of DSM Lecture Brief history Brief overview How to use it Differentials & R/Os malingering, factitious dis, meds/medical, substance, organic Co-morbidity/dual-diagnosis Substance Use/Abuse
More informationDSM-5 Table of Contents
DSM-5 Table of Contents DSM-5 Classification Preface Section I: DSM-5 Basics Introduction Use of DSM-5 Cautionary Statement for Forensic Use of DSM-5 Section II: Essential Elements: Diagnostic Criteria
More informationWhat is Normal Sexual Behavior?
Chapter 11 Paraphilic Disorders, Sexual Dysfunctions, and Gender Dysphoria What is Normal Sexual Behavior? Get into groups of 3-4 and take the sexual behavior survey What is Normal Sexuality? Sexuality
More informationENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS
ENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS MPC 03000 ICD-9 296.2, 296.3, 300.4, 311 ICD-10 F32, F33, F34.1 DEFINITION DEPRESSIVE DISORDERS Depressive Disorders include: Major Depressive Disorder
More informationICD 10 CM Codes for Evaluation & Management October 1, 2017
ICD 10 CM Codes for Evaluation & Management October 1, 2017 Code Description Comments F01.50 Vascular dementia without behavioral disturbance F01.51 Vascular dementia with behavioral disturbance F02.80
More informationChapter 10. Abnormal Psychology Psychological Disorders
Chapter 10 Abnormal Psychology Psychological Disorders APPROACHES ON PSYCHOLOGICAL DISORDERS Approaches Society Individuals Mental Health Professionals APPROACHES OF PSYCHOLOGICAL DISORDERS Approaches
More informationNeurotic, Psychotic or Just Plain Nuts? A Primer of Mental Health Classification
Neurotic, Psychotic or Just Plain Nuts? A Primer of Mental Health Classification Mental health clinicians---all of us, psychologists, psychiatrists, master s level practitioners---use the same classification
More informationProvider Bulletin Philadelphia Department of Behavioral Health Community Behavioral Health State Allowable ICD-9-CM Codes.
Provider Bulletin 07-01 Philadelphia Department of Behavioral Health Community Behavioral Health State Allowable ICD-9-CM Codes. February 12, 2007 The Commonwealth of Pennsylvania lists the allowable ICD-9-CM
More informationHIBBING COMMUNITY COLLEGE COURSE OUTLINE
HIBBING COMMUNITY COLLEGE COURSE OUTLINE COURSE NUMBER & TITLE: PSYC 1400: Abnormal Psychology CREDITS: 3 (3Lec 0 / Lab) PREREQUISITES: PSYC 1205: General Psychology CATALOG DESCRIPTION: Abnormal Psychology
More informationChapter 7. Screening and Assessment
Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions
More informationQuick Study: Sex Therapy
Quick Study: Sex Therapy Sexual Dysfunction: Difficulty experienced by an individual or couple during the stages of normal sexual activity including physical pleasure, desire, arousal, or orgasm. Assessing
More informationWhat is Sexual Deviance?
What is Sexual Deviance? Robin J. Wilson, PhD, ABPP dr.wilsonrj@verizon.net www.robinjwilson.com Classical Perspectives on Sexual Deviance Sexual contact between men and boys was known and discussed in
More informationThe Evolving Definition of Pathological Gambling in the DSM-5
The Evolving Definition of Pathological Gambling in the DSM-5 By Christine Reilly and Nathan Smith National Center for Responsible Gaming One of the most anticipated events in the mental health field is
More informationbetween "hypersexual" and "asexual"
Tensions in sexual scripts: between "hypersexual" and "asexual" AIUS / SFMS Symposium ESSM Copenhagen 2015 Alain Giami INSERM U 1018 Le Kremlin Bicêtre, France A social science perspective Medical and
More informationThe Virtual En-psych-lopedia by Dr. Bob. DSM-IV Diagnoses and Codes, Alphabetical Listing
The Virtual En-psych-lopedia by Dr. Bob DSM-IV Diagnoses and Codes, Alphabetical Listing DSM-5 listings: alphabetical, by diagnosis numerical, by ICD-9-CM and ICD-10-CM code This is just an alphabetical
More informationMen s Sexual Health. Bell curve distribution. What is a normal libido? Everyone is different! Confused society. Hypoactive Sexual Desire Disorder
Men s Sexual Health 1. Too little or loss of libido 2. Too much of a good thing Bell curve distribution Dr Margaret Redelman Medical sex therapist Sydney Men s Health Bondi Junction Society of Australian
More informationAN OVEVIEW OF GAMBLING ADDICTION
AGAINST ALL ODDS AN OVEVIEW OF GAMBLING ADDICTION Brian L. Bethel, M.Ed., PCC-S, LCDC III, RPT-S Reproduction of training material without consent of Brian Bethel is prohibited. 1 Activity #1 Values Something
More informationGoal: To recognize and differentiate different patterns of behavior that show evidence of addiction and inadequate impulse-control
Goal: To recognize and differentiate different patterns of behavior that show evidence of addiction and inadequate impulse-control Addiction and Impulse-Control Bad behavior versus sick behavior Is bad
More informationWhat are Sexual Disorders?
What are Sexual Disorders? CLASS OBJECTIVES: What is Gender Identity Disorder? What are Paraphilias? What is Normal Sexual Behavior? Get into groups of 3-4 Take the sexual behavior survey What is Normal
More informationClient s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone:
Client s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone: Private email address: Student? If yes, where and major? May we leave
More informationManaging Boundaries and Multiple Relationships
Dual and Multiple Relationships in Perspective Managing Boundaries and Multiple Relationships Chapter 7 Psychology 475 Professional Ethics in Addictions Counseling Listen to the audio lecture while viewing
More informationThe Addictive Process
The Addictive Process Models, Theories, and More W. Bryce Hagedorn, PhD, LMHC, NCC, MAC But first, how about some DSM Criteria? Abuse a maladaptive pattern of substance use leading to of the following
More informationParaphilias. Gérard Labuschagne THREAT MANAGEMENT
Paraphilias Gérard Labuschagne THREAT MANAGEMENT Outline of lecture Introduction Diagnostic elements Scale of severity Extent & most common Why do they occur? Link to crime Types Introduction An intense
More informationClassification of Mental Disorders. Prepared By: Dr. Vijay Kumar Lecturer Department of Psychology PGGCG-11, Chandigarh
Classification of Mental Disorders Prepared By: Dr. Vijay Kumar Lecturer Department of Psychology PGGCG-11, Chandigarh Diagnosing Psychological Disorders: Foundations in Classification Clinical Assessment
More informationYour journal: how can it help you?
Journal Your journal: how can it help you? By monitoring your mood along with other symptoms like sleep, you and your treatment team will be better able to follow the evolution of your symptoms and therefore
More informationSexual Aversion. PP7501: Adult Psychopathology
Sexual Aversion PP7501: Adult Psychopathology What is Sexual Aversion? The individual reports anxiety, fear, or disgust when confronted by sexual opportunity. What is Sexual Aversion NOT? Loss of desire
More informationSlide 1. Slide 2. Slide 3 Similar observations in all subsets of the disorder. Personality Disorders. General Symptoms. Chapter 9
Slide 1 Personality Disorders Chapter 9 Slide 2 General Symptoms Problems must be part of an enduring pattern of inner experience and behavior that deviates significantly from the expectations of the individual
More informationSexual & Gender Identity Disorders
Sexual & Gender Identity Disorders Please turn off your cell phones! Sexual & Gender Identity Disorders Gender Identity Disorder (Transsexualism) Sexual Dysfunction Hypoactive Sexual Desire Disorder Sexual
More informationChapter Two. Classification and treatment plans
Chapter Two Classification and treatment plans Diagnosis Definition Good Dx Reliability & Validity History DSM-IV Other choices Weaknesses Treatment Outline 2 3 1. How do you feel about Dx? 4 Assessment
More informationMeasure #106 (NQF 0103): Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity
Measure #106 (NQF 0103): Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity 2014 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage
More informationDo I Have a Drinking Problem?
People drink for all sorts of reason. Some reasons are to socialize, celebrate and relax. Other times people use alcohol as a form of self-medication to help them manage stress, anxiety or to use it to
More informationHow to Win Friends and Influence People Lesson 6 Psychological Patterns and Disorders
How to Win Friends and Influence People Lesson 6 Psychological Patterns and Disorders What are psychological disorders? Mental health workers view psychological disorders as ongoing patterns of thoughts,
More informationSEX AND LOVE ADDICTION
[ 0] SEX AND LOVE ADDICTION The following list is a thought starter to help identify your habits of thoughts and feelings in the area of Sex and Love Addiction. Go through the whole list first marking
More informationVirtual Mentor American Medical Association Journal of Ethics August 2010, Volume 12, Number 8:
Virtual Mentor American Medical Association Journal of Ethics August 2010, Volume 12, Number 8: 673-677. MEDICINE AND SOCIETY Proposed DSM-5 Revisions to Sexual and Gender Identity Disorder Criteria Robert
More informationSubstance Use Disorders
Substance Use Disorders Substance Use Disorder This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars monthly to address topics related to risk adjustment documentation and
More informationMOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS
MOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS Shelley Klipp AS91 Spring 2010 TIP 42 Pages 226-231 and 369-379 DSM IV-TR APA 2000 Co-Occurring Substance Abuse and Mental Disorders by John Smith Types
More informationResidual Functional Capacity Questionnaire MENTAL IMPAIRMENT
Residual Functional Capacity Questionnaire MENTAL IMPAIRMENT Patient: DOB: Physician completing this form: Please complete the following questions regarding this patient's impairments and attach all supporting
More informationThe Dance of Destruction:
The Dance of Destruction: Compulsive Behaviors and Process Addictions Presented By: Coleen Moore, MA, LCPC, CAADC, CCGC, MISA II, SAP Housekeeping... Take care of you move about as needed Share openly
More informationFirst the Man Takes a Drink... Texas Lawyers Assistance Program September, 2014 Marilyn J Vaché MD, Medical Director, Austin Recovery
First the Man Takes a Drink... Texas Lawyers Assistance Program September, 2014 Marilyn J Vaché MD, Medical Director, Austin Recovery Everyone who drinks alcohol is at risk of losing control of drinking,
More informationSexually Violent Predator Evaluations
California Department of Mental Health Sexually Violent Predator Evaluations An Introduction A reintroduction Ronald J. Mihordin, M.D., J.D., M.S.P. Acting Clinical Director Evaluation Service Sex Offender
More information*Many of these DSM 5 Diagnoses might also be used to argue for eligibility using Other Health Impaired Criteria
Handout 2: DSM 5 Diagnoses that May be Associated with One or More of the Five ED Characteristics* 1. An inability to learn that cannot be explained by intellectual, sensory, or health factors. a) Selective
More informationMarch 29, 2017 Debra K. Smith, Ph.D. St. Charles Hospital Port Jefferson, New York
Traumatic Brain Injury: Management of Psychological and Behavioral Sequelae March 29, 2017 Debra K. Smith, Ph.D. St. Charles Hospital Port Jefferson, New York The Functional Impact of
More informationThe psychological disorders
The psychological disorders Defining abnormal Statistical infrequency Normal distribution; the normal curve Violation of norms Culture bound syndromes Personal distress Some disorders do not involve distress
More informationIndividual Planning: A Treatment Plan Overview for Individuals with Impulse Control Problems.
COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals with Impulse Control Problems. Individual Planning: A Treatment Plan Overview for Individuals Suffering
More informationENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS
ENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS MPC 03000 ICD-9 296.2, 296.3, 300.4, 311 ICD-10 F32, F33, F34.1 DEFINITION Depressive Disorders is a category of conditions in the Diagnostic and
More informationDepressive and Bipolar Disorders
Depressive and Bipolar Disorders Symptoms Associated with Depressive and Bipolar Disorders Characteristics of mood symptoms Affects a person s well being, school, work, or social functioning Continues
More informationTable of substance use disorder diagnoses:
Table of substance use disorder diagnoses: ICD-9 Codes Description 291 Alcohol withdrawal delirium 291.3 Alcohol-induced psychotic disorder with hallucinations 291.4 Idiosyncratic alcohol intoxication
More informationCLASSIFICATION AND TREATMENT PLANS
CLASSIFICATION AND TREATMENT PLANS C H A P T E R 2 EXPERIENCES OF CLIENT AND CLINICIAN PSYCHOLOGICAL DISORDER: EXPERIENCES OF CLIENT AND CLINICIAN Psychologist: Healthcare professional offering psychological
More informationPresenters: Dr. Sadie Sheafe PhD, LCSW, ABS Dip Dr. Douglas Muller PhD, LCSW, LPC Dr. William Harper PhD, RAS, BHRS, CAS
Presenters: Dr. Sadie Sheafe PhD, LCSW, ABS Dip Dr. Douglas Muller PhD, LCSW, LPC Dr. William Harper PhD, RAS, BHRS, CAS Participants will discuss: 1. The Cycle Of Sexual Addiction Participants will discuss:
More informationPROBLEMATIC SEXUAL BEHAVIORS 101
1 PROBLEMATIC SEXUAL BEHAVIORS 101 Todd Connaughty, MA, LPCC, LADC Pride Institute Todd.connaughty@uhsinc.com www.pride-institute.com 952-934-7554 Mission: The Society for the Advancement of Sexual Health
More informationPsychology Session 11 Psychological Disorders
Psychology Session 11 Psychological Disorders Date: November 18th, 2016 Course instructor: Cherry Chan Mothercraft College Agenda 1. Normal vs. Abnormal 2. Communication disorders 3. Anxiety disorders
More informationKAP Keys. For Clinicians. Based on TIP 24 A Guide to Substance Abuse Services for Primary Care Clinicians. CSAT s Knowledge Application Program
KAP KEYS Based on TIP 24 A Guide to Substance Abuse Services for Primary Care CSAT s Knowledge Application Program KAP Keys For Based on TIP 24 A Guide to Substance Abuse Services for Primary Care U.S.
More informationWelcome & Introductions. General Rules, Expectations and Housekeeping
Welcome & Introductions General Rules, Expectations and Housekeeping Welcome Ken Litwak, BA, ICGC-1, CCTP 800gambler.org Who is 800- GAMBLER? Council on Compulsive Gambling of New Jersey, Inc. 3635 Quakerbridge
More informationENTITLEMENT ELIGIBILITY GUIDELINE SCHIZOPHRENIA
Entitlement Eligibility Guideline SCHIZOPHRENIA Page 1 of 8 ENTITLEMENT ELIGIBILITY GUIDELINE SCHIZOPHRENIA MPC 00607 ICD-9 295 ICD-10 F20 DEFINITION SCHIZOPHRENIA Characteristic symptoms of Schizophrenia
More informationPsych Grand Rounds. Disclosure. My books
for Asperger Syndrome and Other Related Disorders Practical Strategies for Assessment Practical Strategies and for Treatment Assessment and Treatment Illustrated by Laura S. Kowalski A Simple Technique
More informationFive Changes in DSM 5 Principles for Primary Care. Tom Janzen, M.D. STEGH Mental Health May 14, 2014
Five Changes in DSM 5 Principles for Primary Care Tom Janzen, M.D. STEGH Mental Health May 14, 2014 Overall Learning Objectives Review 5 changes to DSM 5 which have significance for Family Physicians Examine
More information7 DSM Codes. CARE System April 2013 DSM Codes 7-1
7 DSM Codes This section contains codes and decode values used in CARE from the current edition of the and Statistical Manual of Mental Disorders. There is also an Axis (Axis 1, Axis 2, or Blank for both)
More informationPsychological Disorders
1 2 3 4 5 Psychological Disorders Perspectives on Psychological Disorders Societal Does the behavior conform to existing social norms? Individual Personal sense of well-being Happy, satisfied, peaceful
More informationNivedita Dhar M.D. Wayne State University April 25, 2013
Female Sexual Dysfunction Nivedita Dhar M.D. Wayne State University April 25, 2013 Outline Define Sexual Health and Wellness and discuss how it is unique to each individual Discuss the current terminology
More informationWhat are Sexual Disorders?
What are Sexual Disorders? CLASS OBJECTIVES: What is Gender Identity Disorder? What are Paraphilias? What is Normal Sexual Behavior? Get into groups of 3-4 and take the sexual behavior survey What is Normal
More informationSubstance and Alcohol Related Disorders. Substance use Disorder Alcoholism Gambling Disorder
Substance and Alcohol Related Disorders Substance use Disorder Alcoholism Gambling Disorder What is a Substance Use Disorder? According to the DSM-5, a substance use disorder describes a problematic pattern
More informationPersonality Disorders
Personality Disorders Personality Disorders Using DSM system Longstanding difficulties coded on Axis II Idea is to capture developmental concerns Often described as problems more interpersonal in nature
More informationACBHCS Outpatient Included List DHCS ICD-10
12-19-17 ACBHCS Mental Health Outpatient (includes PES/CSU) Crosswalk Medi-Cal Included Dx List Numeric by Code (Crossed out diagnoses are not allowed. Always use the code) Instructions: Crossed out diagnoses
More informationAlcohol, sex and love:
Alcohol and sex Alcohol, sex and love: DO THEY STILL GO HAND IN HAND? WHAT DOES LOW-RISK DRINKING MEAN? - For women, no more than 2 drinks a day, maximum 10 drinks a week. - For men, no more than 3 drinks
More informationChanges to the Organization and Diagnostic Coverage of the SCID-5-RV
Changes to the Organization and Diagnostic Coverage of the SCID-5-RV Core vs. Enhanced SCID configuration A number of new disorders have been added to the SCID-5-RV. To try to reduce the length and complexity
More informationACBHCS Outpatient Included List DHCS ICD-10
12-19-17 ACBHCS Mental Health Outpatient (includes PES/CSU) Crosswalk Medi-Cal Included Dx List-Alpha by Name (Crossed out diagnoses are not allowed. Always use the code) Instructions: Crossed out diagnoses
More informationABNORMAL PSYCHOLOGY. Psychological Disorders. Fast Track Chapter 11 (Bernstein Chapter 15)
ABNORMAL PSYCHOLOGY Psychological Disorders Fast Track Chapter 11 (Bernstein Chapter 15) Introduction to Abnormal Psychology PSYCHOPATHOLOGY the study of the causes, symptoms, and development of psychological
More informationObsessions: Thoughts, images, behaviors, impulses reappear despite the person s effort to suppress them.
Chapter 12 Psychological Disorders Part Two Anxiety Disorders Obsessive-Compulsive Disorder Condition characterized by patterns of persistent, unwanted thoughts and behaviors Obsessions: Thoughts, images,
More informationMotivation and Emotion
Motivation and Emotion Chapter 8 Motivation and Emotion I. What is Motivation II. III. How Does Motivation Affect Behavior? What is Emotion? IV. How Does Emotion Affect Behavior? What is Motivation? A
More informationMental Health and Stress
Mental Health and Stress Learning Objectives Ø Define mental health and discuss the characteristics of mentally healthy and selfactualized people Ø Describe the various mental disorders and appropriate
More informationObsessive Compulsive and Related Disorders
Obsessive Compulsive and Related Disorders Obsessive-Compulsive and Related Disorders Obsessive-Compulsive and Related Disorders Obsessive -Compulsive Disorder (OCD) Body Dysmorphic Disorder Hoarding Disorder
More informationDefining Mental Disorders. Judy Bass, MPH, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER
ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER MPC 00620 ICD-9 309.81 ICD-10 43.1 DEFINITION Posttraumatic Stress Disorder (PTSD) is a condition in the Diagnostic and Statistical Manual
More informationMood Disorders for Care Coordinators
Mood Disorders for Care Coordinators David A Harrison, MD, PhD Assistant Professor, Dept of Psychiatry & Behavioral Sciences University of Washington School of Medicine Introduction 1 of 3 Mood disorders
More information